Glandula adrenalis

Glandula adrenalis sive glandula suprarenalis^[1]^[2] est gemina glandula endocrinea, quae supra utrumque renem sita est. Constituta est duabus ex partibus, cortex et medulla. Hae glandulae varia hormonta, inter quae et glucocorticoida et adrenalinum, effundunt. Gubernatio per hormonta cerebralia fit.

Cave: notitiae huius paginae nec praescriptiones nec consilia medica sunt.

Glandulae adrenales Glandulae suprarenales
Cognitores
TA	A11.5.00.001
Anatomia

Situs glandulae supra renes, in spatio retroperitoneali.
Systema	endocrineum

Insufficientia corticis glandularum renalium vocacitur morbus Addisonianus. Si rarius, at repentino, paucis sub horis morbus aggravescat, crisis Addisoniensis vel crisis adrenalis dicitur^[3].

In animalibus non paucis ambo glandulae organa, cortex et medulla, separata iacent: organum corticale enim et organum medullare.

Anatomia

Anatomia macroscopica

Glandula suprarenalis dextra trianguli instar, sinistra lunae

Sitae sunt glandulae suprarenales, una cum renis, in spatio retroperitoneali, circumclusae renis capsulis et fibrosa et adiposa, velut organi capsula.

Utraque glandula galeri - latere dextro triangularis, laevo lunati - instar videtur, supra renem basi imposita. Videntur utroque latere basis, facies posterior, msrgo superior, margo medialis, dextro etiam apex. Utriusque glandulae pondus est 5-15 g.

In adultis ponderis relatio inter renem et glandulam est 30:1 (in neonatis 3:1).

Providentia vascularis

Providentia sanguinea abunde videtur. Utraque glandula suprarenalis sanguinem arterialem uniformiter trium arteriarium suprarenalium ope recipit. Effluxus venosus utriusque lateris diversus est, at invenitur utroque latere vena suprarenalis. Vasa lymphacea in regiones et lumbalis et coeliacam currunt. Connectitur quoque utraque glandula suprarenalis cum systemate nervoso autonomico.

Arteriae. Utrique glandulae suprarenali tres arteriae ex arteria phrenica inferiore et arteria renali affluunt: Arteriae suprarenales superior, media, inferior. Arteriarum variantes descriptae sunt^[4].

Situs abdominalis cum glandulis suprarenalibus

Anatomia microscopica

In sectione histologica divisio inter capsulam (partem minorem), corticem sive substantiam corticalem (partem maiorem, usque ad 80%), et medullam sive substantiam medullarem visibilis est. Sine coloratione histologica cortex color flava, at medulla color rubescens ostendunt. Inter sustantias corticales et medullares reperiuntur fasciculi textuum connectivorum. Capsula adiposa ex textu adiposo, capsula fibrosa ex textu connectivo formantur.

Sectio histologica glandulae suprarenalis humanae sub microscopio visa, glandulae laminas ostendens: ab superficie ad centrum visibiles sunt zona glomerulosa, zona fasciculata, zona reticularis, medulla. In substantiae medullaris medio vena adrenomedularis centralis secta invenitur. Notanto corticis aspectum columnalem infra zonam glomerulosam (parte magis conspicue colorata).

Anatomia microscopica corticis

In cortice adultorum ipso distinguuntur tres zonae, ab externa ad internam:

zona glomerulosa (extrorsum) imprimis generationis mineralocorticoidorum, ut aldosteroni: lamina tenuior; ut zonae nomen indicat invenitur cellulares corticales glomeruli ordinatae,
zona fasciculata (in medio) formationis glucocorticoidorum, ut cortisoli: lamina latior, columnis (sive fasciculis, ita fasciculata nominata) ordinata,
zona reticularis (introrsum) formationis androgenorum, ut testosteroni: lamina tenuior, cellulis eosinophilis, retiumformibus striis.

Nimirum cellularum formae ab externis ad internas mutat, globuliformibus enim ab externis ad cylindricas internas.

Commutationationes corticis anatomicae

In vitae cursu relationes inter tres eas zonas constanter commutatur, sub aetatibus enim atque sub status contentionis animi.

In neonatis zonae glomerulosa et reticularis tenuiores videntur, posteaquam vialiter crescunt; denique in pubertate illarum latitudines maiores et clariores apparent. Imprimis in feminis distributio triplex clare visibilis est.

Zona fasciculata autem contentione animi chronica latior apparet, quia hormontis ACTH ope lipida magis accumulari putatur.

Anatomia microscopica medullae

Constituta est medulla ex cellulis epithelialibus polygonalibus. Colorationes histologicae, quae chromium continent, cellulis his chromii sales acceptis, colorationem fuscum dant, hac de causa cellulae chromaffinae, rarius phaeochromaticae, nominatae sunt.

Embryologia

Utraque pars, cortex et medulla, procreationem separatam (originem dualem) ostendit. Origo corticis est mesodermatis; medulla autem ab ectodermate formatur. Uterque cortex una cum utroquo gonado, ovario vel teste, ab plica genitali (in embryone locis renium inferiorum) derivantur, nimirum interdum textus aberrans glandulae adrenalis inter renes et plexum testicularem inveniri potest^[5].

Cortex

Cortex glandulae suprarenalis ex coelomatis epithelio et plicae genitalis crescit. Coeloma in utero cavitas embryonis inter intestinum et corporis parietem externum formatur.

Medulla

Medulla autem de plicae neuralis derivatur.

Physiologia

Corticis et medullae munera sunt diversa: Cellulae corticis genera tria hormontum secernunt: mineralocorticoida, glucocorticoida, hormonta sexualia. Cellulae medullae autem sunt pars systematis nervosi autonomici. Ut in anatomia sub aspectu physiologica glandulis supraerenalibuss late duo organa separata insunt, hac de re separatim disserenda.

Physiologia corticis glandulae suprarenalis

Glandulae suprarenales tria genera hormontum secernunt: mineralocorticoida, glucocorticoida, androgena. Coniuncta est generatio mineralocorticoidorum cum sanguinis pressione, glucocorticoidorum cum contentione enervante biologica, androgenorum cum sexualitate. Olim se unice ea in sanguinem liberare putatum est, hodie tamen synthesis extraadrenalis omnium trium generum nota est^[6]. Gubernatio principalis per hypothalamum partem cerebri et glandulam pituitariam (axem HPA - hypothalamicum–pituitarium–adrenalem - dictum) oritur.

Zona glomerulosa et mineralocorticoida

Conferatur pagina principalis Mineralocorticoidum.

Intra zona glomerulosa canales iontici calcii tensione pendentes locati sunt^[7].

Mineralocorticoida, per receptoria propria (receptoria mineralocorticoidorum), mutationes aequilibriorum natrii Na⁺ et kalii K⁺ et aquae H₂O, ita etiam sanguinis pressionis efficiunt^[8]. Mineralocorticoidum aldosteronum

concentrationem sanguineam Na⁺ auget, reabsorptionis ope natrii ex urina, saliva, faecibus, quo fit, ut aqua in spatium extracelluare influat;
in renium cellulis parietalibus quoque Na⁺ retinetur, pariter K⁺ et hydrogenium H⁺ in tubulos renales emittuntur, quo fit, ut urinae K⁺ diuresis plus pH deminutionem (urinas acidas) ostendunt.

Vice versa insufficientia glandularum cum generationis deminutione mineralocorticoidorum valores minores natrii, at kalii altiores.

Axis hypothalamicus–pituitarius–adrenalis (axis HPA)

Axis HPA actiones et retroactiones inter cerebri hypothalamum et per hormon resolvens CRH (corticotropini resolvens hormon) hypophysem (= glamdulam pituitariam), denique per hormon ACTH (adrenocorticotropinum hormon) cortices glandularum suprarenalium describit. Munus axis HPA est synthesis corticoidorum adrenalium gubernandi.

Biochemia

Generant corticis cellulae ex cholesterolo plus quam triginta hormontum steroidorum, quae cellularum itinera metabolica, per exemplum, gluconeogenesem catalysant. Tria genera hormontum steroidorum nota sunt: mineralocorticoida, glucocorticoida, androgena; eorum synthesis quaedam cytochromata P450 enzyma requirit.

Synthesis hormontum steroidorum

Cholesterolum est substantia hormontum adrenalium antecessor. Ei 27 atomi carbonii (C₂₇) sunt.

Substantia principalis est cholesterolum, cum atomis carbonii viginti septem (C₂₇) et nucleo cyclopentanoperhydrophenanthreno. Conversionis primae in pregnenolonum, cum carbonii atomis viginti unis (C₂₁), enzymum mitochondriale cholesteroli desmolasis, CYP11A, necesse est. Pregnenolono exeunte partitio fit:

partim ad mineralocorticoida et glucocorticoida (utrumque C₂₁ quoque) per progesteronum; divisio inter mineralocorticoida et glucocorticoida ab progesterono fit.
partim ad androgena, cum carbonii atomis undeviginti (C₁₉^[9]) per DHEA (dehydroepiandrosteronum).

Synthesis aldosteroni mineralocorticoidi

Adrenocorticotropino hormono (ACTH) stimulata synthesis aldosteroni in zona glomerulosa fit: Ex cholesterolo enzymi CYP11A1 ope oritur pregnenolonum, deinde progesteronum fabricatur, post hoc 11-deoxycorticosteronum, corticosteronum, 18-hydroxcorticosteronum, demum aldosteronum.

Mineralocorticoidum naturale principale, aldosteronum, ex cholesterolo in gradibus sex formatur:

Cholesterolum → Pregnenolonum (synthesis pregnenoloni haec in gonadis, glandulis adrenalibus, cerebro)
Pregnenolonum → Progesteronum
Progesteronum → 11-Deoxycorticosteronum (enzymi 21-hydroxylasis auxilio) (praeterea per 17α-hydroxylasem in 17-Hydroxprogesteronum - versus cortisolum)
11-Deoxycorticosteronum → Corticosteronum
Corticosteronum → 18-Hydroxycorticosteronum
18-Hydroxycorticosteronum → Aldosteronum

Synthesis cortisoli glucocorticoidi

Conferatur pagina principalis Cortisolum.

Synthesis cortisoli in corticis adrenalis strato medio (zona fasciculata) fit.

Cholesterolum → Pregnenolonum
Pregnenolonum → Progesteronum
Progesteronum → 17-Hydroxprogesteronum per 17α-hydroxylasem
17α-Hydroxprogesteronum → 11-Deoxycortisolum
11-Deoxycortisolum → Cortisolum

Extra glandulas adrenales ex cortisolo formantur cortisonum (abhinc tetrahydrocortisonum et allo-tetrahydrocortisolum), 18-hydroxycortsolum (dein oxocortisolum), tetrahydrocortisolum, allo-tetrahydrocortisolum.

Mala et morbi glandularum suprarenalium

In senectute degeneratio zonae glomerulosae observatur^[10]. Chronica animi contentione et mentis morbis latitudo conspicue aucta zonae fasciculatae observari potest^[11]. Aldosteronismus primarius sive syndroma Conn ad generationem aldonsteroni immoderatam spectat. Insufficientia corticis glandularum suprarenalium morbus Addisonianus nominatur. Rarissime mutationes geneticae geni ABCD1 cum glandulae insufficientia quoque coniunctae sunt: adrenoleucodystrophia^[12]^[13] et adrenomyeloneuropathia^[14]. Interdum glandularum tumores adenomata observantur^[15].

Notae

↑ Kraus, L.A. (1844). Kritisch-etymologisches medicinisches Lexikon (editio 3). Gottingae: Verlag der Deuerlich- und Dieterichschen Buchhandlung.
↑ Federative Committee on Anatomical Terminology (1998). Terminologia Anatomica. Stutgardiae: Thieme
↑ Dineen R., Thompson C. J,, Sherlock M. (Iun 2019). "Adrenal crisis: prevention and management in adult patients". Therapeutic advances in endocrinology and metabolism: 10:2042018819848218
↑ Manso J.C., DiDio L.J. (Sep 2000). "Anatomical variations of the human suprarenal arteries". Annals of anatomy 182 (5): 483-8
↑ Anakievski D., Malinova D. (Sep 2019). "Heterotopic adrenal gland in undescendent testis - Case report". Urology case reports 27
↑ Taves M. D., Gomez-Sanchez C. E., Soma K. K. (Iul 2011). "Extra-adrenal glucocorticoids and mineralocorticoids: evidence for local synthesis, regulation, and function". American journal of physiology, endocrinology, and metabolism 301 (1): E11-24
↑ Felizola S. J. A., Maekawa T. (Oct 2014). "Voltage-gated calcium channels in the human adrenal and primary aldosteronism". The journal of steroid biochemistry and molecular biology 144 Pt B: 410-6
↑ Gomez-Sanchez E. P., Gomez-Sanchez C. E. (Mar 2012). "Central regulation of blood pressure by the mineralocorticoid receptor". Molecular and cellular endocrinology 350 (2): 289-98
↑ Auxilio: Nomen longius (mineralo-/glucocorticoidum): C₂₁, nomen brevius (androgenum): C₁₉.
↑ Nanba K., Vaidya A., Rainey W. E. (Feb 2018). "Aging and Adrenal Aldosterone Production". Hypertension 71 (2): 218-23
↑ Busch J. R., Lundemose S. B., et al. (Ian 2020). "Enlargement of the human adrenal zona fasciculata and chronic psychiatric illness - an autopsy-based study". Stress 23 (1): 69-76
↑ Turk B. R., Theda C., Fatemi A., Moser A. B. (Feb 2020). "X-linked adrenoleukodystrophy: Pathology, pathophysiology, diagnostic testing, newborn screening and therapies". International journal of developmental neurology 80 (1): 52-72 doi:10.1002/jdn.10003
↑ Zhu J., Eichler F., Biffi A., Duncan C. N., Williams D. A., Majzoub J. A. (Aug 2020). "The Changing Face of Adrenoleukodystrophy". Endocrine reviews 41 (4): 577-93 doi:10.1210/endrev/bnaa013
↑ Mehndiratta M. M., Rao K. B., Garg S., Pandey S. (Iun 2005). "Adrenomyeloneuropathy". The journal of the Association of Physicians of India 53: 562-3
↑ Kazutaka Nanba K., Chen A. X., et al. (Mar 2016). "Molecular Heterogeneity in Aldosterone-Producing Adenomas". The journal of clinical endocrinology and metabolism 101 (3): 999-1007

Nexus interni

[Kraus-1] Kraus, L.A. (1844). Kritisch-etymologisches medicinisches Lexikon (editio 3). Gottingae: Verlag der Deuerlich- und Dieterichschen Buchhandlung.

[FCAT-2] Federative Committee on Anatomical Terminology (1998). Terminologia Anatomica. Stutgardiae: Thieme

[3] Dineen R., Thompson C. J,, Sherlock M. (Iun 2019). "Adrenal crisis: prevention and management in adult patients". Therapeutic advances in endocrinology and metabolism: 10:2042018819848218

[4] Manso J.C., DiDio L.J. (Sep 2000). "Anatomical variations of the human suprarenal arteries". Annals of anatomy 182 (5): 483-8

[5] Anakievski D., Malinova D. (Sep 2019). "Heterotopic adrenal gland in undescendent testis - Case report". Urology case reports 27

[6] Taves M. D., Gomez-Sanchez C. E., Soma K. K. (Iul 2011). "Extra-adrenal glucocorticoids and mineralocorticoids: evidence for local synthesis, regulation, and function". American journal of physiology, endocrinology, and metabolism 301 (1): E11-24

[7] Felizola S. J. A., Maekawa T. (Oct 2014). "Voltage-gated calcium channels in the human adrenal and primary aldosteronism". The journal of steroid biochemistry and molecular biology 144 Pt B: 410-6

[8] Gomez-Sanchez E. P., Gomez-Sanchez C. E. (Mar 2012). "Central regulation of blood pressure by the mineralocorticoid receptor". Molecular and cellular endocrinology 350 (2): 289-98

[9] Auxilio: Nomen longius (mineralo-/glucocorticoidum): C₂₁, nomen brevius (androgenum): C₁₉.

[10] Nanba K., Vaidya A., Rainey W. E. (Feb 2018). "Aging and Adrenal Aldosterone Production". Hypertension 71 (2): 218-23

[11] Busch J. R., Lundemose S. B., et al. (Ian 2020). "Enlargement of the human adrenal zona fasciculata and chronic psychiatric illness - an autopsy-based study". Stress 23 (1): 69-76

[12] Turk B. R., Theda C., Fatemi A., Moser A. B. (Feb 2020). "X-linked adrenoleukodystrophy: Pathology, pathophysiology, diagnostic testing, newborn screening and therapies". International journal of developmental neurology 80 (1): 52-72 doi:10.1002/jdn.10003

[13] Zhu J., Eichler F., Biffi A., Duncan C. N., Williams D. A., Majzoub J. A. (Aug 2020). "The Changing Face of Adrenoleukodystrophy". Endocrine reviews 41 (4): 577-93 doi:10.1210/endrev/bnaa013

[14] Mehndiratta M. M., Rao K. B., Garg S., Pandey S. (Iun 2005). "Adrenomyeloneuropathy". The journal of the Association of Physicians of India 53: 562-3

[15] Kazutaka Nanba K., Chen A. X., et al. (Mar 2016). "Molecular Heterogeneity in Aldosterone-Producing Adenomas". The journal of clinical endocrinology and metabolism 101 (3): 999-1007

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